Participatory research, including co-production, is highly valued in health- and community-focused research. Evaluating outcomes of co-production activities is essential to informing and improving future efforts. The study aimed to evaluate the experiences of participants involved in co-production to develop a National Framework for assessing children's functional strengths and support needs. The National Framework was developed to guide professionals when working with children aged 0-12 years, including children who do and do not have one or more diagnosed condition(s), and their families in Australia and inform good policy across health, education, disability, and community support sectors. We used a cross-sectional descriptive survey study design. We invited representatives of 23 community and professional organisations who were involved in co-production, to complete an online survey. Thirteen individuals accepted the invitation. Participants provided quantitative and qualitative reflections regarding the extent to which the co-production process was accessible, inclusive, respectful, participatory, helpful and outcomes focussed. Data from the online survey were analysed using descriptive statistics and open-ended responses used to illustrate the findings. Participants reported the co-production process was highly positive, inclusive and respectful. Most reflected positively on their experience (e.g., accessibility, inclusiveness) and outcomes (e.g., open to refining ideas, aims achieved). However, some variability was noted due to the consensus-seeking approach used which resulted in not all individual contributions being fully reflected in the final product. The findings provide further evidence of the value and importance of co-production for designing and delivering community-focused initiatives. Recommendations for further enhancing the approach, experience, and outcomes of co-production activities for the individuals involved are provided. These include establishing detailed documentation of the co-production methods used, establishing participants' expectations, and supporting open discussion of what went well/not well in co-production. This study shows participant perspectives on the co-production process and the importance of considering co-production outputs, experiences, and outcomes to understand such perspectives. Examples of strategies that can support well-organised, respectful and purposeful engagement are provided. The participants include people with lived experience advocating for individuals and professionals. Three authors report first-hand lived experience of disability.
Early Career Investigators (ECIs) often have limited access to structured, comprehensive training in the development and conduct of interventional clinical trials. EORTC supports ECIs through dedicated educational and professional growth initiatives. We report the design and outcomes of the 2025 EORTC multi-session program for ECIs. The program consisted of an introductory prerecorded session and nine live sessions, including seven virtual sessions and two in-person meetings. Using the fully virtual EORTC program delivered in 2023 as a benchmark, the 2025 program introduced a hybrid format, strong integration of EORTC Task Forces, structured training in clinical trial proposal development, and stricter participant selection. Outcome measures included attendance and completion rates, research proposal outputs, and participant evaluation of the course. Between May and November 2025, 40 ECIs (predominantly medical oncologists) from 12 European countries participated. Overall attendance across the nine live sessions significantly increased from 71.7% in 2023-96.4% in 2025, and the completion rate increased from 33.3% to 92.5%. Seventeen research proposals were developed and refined throughout the program. Participant evaluations were highly positive, highlighting perceived benefits in networking and clinical research knowledge and skills and increased motivation and inspiration for future research activities. The 2025 EORTC ECI program addressed an unmet need among ECIs for structured clinical trial training and achieved high attendance, completion, and participant satisfaction, while supporting the development of new research proposals. Dedicated support from funders, governments, and policymakers is essential for future improvement and continuation of such initiatives.
Patient and Public Involvement (PPI) is becoming increasingly common in research and is now a requirement by many funding bodies. In this paper, we describe a PPI Board that was formed to bring lived experience expertise to the research conception, development and implementation of the evaluating quality care (eQC) project, which focussed on improving the care of older people and people living with dementia in acute care hospitals. We discuss how the board was initially conceived and developed, including the process to recruit an appropriately skilled and experienced Chair and members, and operational aspects of the co-design focused Board. The Board's membership, conduct of meetings and outcomes are described. The Board's eight members provided advice and input on research ideas and protocols. They co-authored 16 publications and provided advice and input on a further 12 publications for three PhD students linked with the project. Important aspects of PPI, including successes and challenges of setting up a PPI Board are discussed as well as recommendations for other groups who are interested in developing a PPI Board as co-design partners in research. The eQC public and patient involvement board comprises people living with dementia and carers of people living with dementia. This article was conceived of and jointly planned with the eQC PPI Board and eQC research team. The research team members wrote the first draft (D.B. and P.P.), and the Board edited the manuscript. All Board members are listed as authors.
This study aimed to identify guiding principles to underpin assessment and diagnosis of autism to improve the quality, consistency and accuracy of services provided to individuals and their families. An online survey and focus groups were used to capture community perspectives of members of the Australian autistic and autism communities. A total of 871 individuals participated across the research activities, including autistic individuals (n = 253), parents of autistic individuals (n = 344), practitioners (n = 325) and members of organisations with an interest in the assessment and/or diagnosis of autism (n = 115). Three overarching themes, encompassing 15 codes, representing the principles that should underpin practice across the assessment and diagnostic process were developed (a) placing the person at the centre of the process; (b) understanding and valuing the whole person and (c) improving quality and access. Assessment and diagnosis for autism should go beyond diagnostic decision-making to include understanding of individual needs and identifying support pathways. The principles identified serve as a first step to guiding practitioners in their approach, ensuring they work in ways that promote best practice, reflect the perspectives of autistic people and engender meaningful outcomes for individuals and families that are independent of receiving a diagnostic label.Lay AbstractThis study looked to identify principles of practice that could help make autism assessments and diagnoses better for autistic people and their families. To do this, the researchers asked people from the autism community in Australia to share their thoughts through an online survey and focus groups. A total of 871 people took part. This included autistic adults, parents of autistic children, professionals like psychologists and speech pathologists and people from autism-related organisations. From what people said, three main ideas stood out: (a) putting people at the centre of the process, (b) looking at the whole person and (c) improving quality and access to services. The study found that getting a diagnosis is just one part of the process. It is also important to use the assessment to help people understand themselves better and find the right support. The principles highlighted in this study can help guide professionals to do a better job when assessing autism. They encourage practices that are respectful, person-focused and based on what autistic people and their families say is important. This can lead to better outcomes for everyone, no matter whether a diagnosis is given or not.
Sub-Saharan Africa (SSA), including Tanzania, is double-burdened with high rates of teenage pregnancy and new HIV infections among adolescent girls and young women (AGYW) aged 15-24 years. Moreover, pregnant AGYW living with HIV in SSA have poorer adherence and retention on HIV treatment and elevated risks of vertical HIV transmission to their infants, as compared with older women. This paper describes the methods for the ENGAGE project, aiming to investigate and optimise healthcare for prevention of vertical HIV transmission (commonly prevention of mother-to-child transmission (PMTCT)) for AGYW living with HIV in Tanzania. ENGAGE uses a mixed-methods design to co-create and prototype an intervention package for pregnant/postpartum AGYW living with HIV through three phases in three Tanzanian regions. Phase 1 characterises the problem by investigating care engagement and outcomes in a cohort of N=10 147 AGYW receiving PMTCT services in routine healthcare. Phase 2 uses qualitative interviews to understand the social-structural drivers of care engagement from the perspective of AGYW, healthcare providers and community stakeholders and an evidence review of potential solutions. In phase 3, we will use findings from phase 1 and 2 to co-create (together with AGYW and healthcare providers) an intervention package to optimise PMTCT care for most at-risk AGYW. The co-creation will be done through an intervention development action cycle, where ideas are presented, feedback sought and refinements made iteratively via several workshops over about 6 months. The resulting co-created intervention package will be prototyped at selected facilities/communities and refined into a final version, ready for piloting for feasibility, acceptability and preliminary effect in a later phase. This protocol focuses on the co-creation phase 3 and its preceding phases 1 and 2. ENGAGE has received ethical approval from the Tanzania National Health Research Ethics Committee (NIMR/HQ/R.8a/Vol.IX/4637), and the Swedish Ethical Review Authority (2024-05745-01) for analysis of data in Sweden. Findings will be disseminated to AGYW, healthcare providers, community stakeholders, health officials, researchers, policy makers and the wider local and global scientific community.
Gender equity for anaesthetists remains elusive, despite patient and clinician benefits. Many strategies have been proposed to promote gender equity, yet women remain under-represented in anaesthesia leadership compared with men. This review identifies contemporary implemented strategies to improve gender equity in anaesthesia leadership. We searched databases for studies published from January 2019 to March 2024, including reports of implementation. We employed state-of-the-art review methodology to provide a current understanding of this complex sociocultural problem, using Cook's and Stufflebeam frameworks for categorisation and deductive data extraction and analysis based on context, inputs, processes and outcomes. We screened 257 abstracts and identified 18 studies for analysis; 14 were conducted in the USA. The most prominent individual interventions were mentorship and sponsorship. These were supported by organisational interventions including professional development curricula; policies; and leadership roles supporting diversity. Two studies reported how programmes were iteratively developed. Reported success metrics included quantitative (increased diversity in leadership, achieving promotion) and qualitative outcomes (networks and wellbeing). Evidence for best practices to address gender equity in anaesthesia leadership is emerging. Prospective determination of key outcomes enables monitoring of success, including representation and wellbeing. Organisational support, in the form of policies and leadership roles linked to diversity outcomes, amplifies the benefits of mentorship and sponsorship. Future interventions should report the context in which the interventions were mobilised, associated costs and details of the iterative programme delivery and development process. WHAT WE DID?: We looked at many recent studies to find out what people are doing right now to help make leadership in anaesthesia more fair for women. We searched for studies from 2019 to 2024 and chose 18 that explained real actions taken to improve gender fairness. WHY DID WE DO IT?: Women are still not employed as often as men in top anaesthesia jobs, even though fairness helps both patients and doctors. Many ideas have been suggested, but we wanted to know which ones are actually being tried and whether they seem to work. WHAT WE FOUND?: The most common helpful actions were mentorship (helping someone learn and grow) and sponsorship (supporting someone so they can get new opportunities). Hospitals and organisations also used policies, training programmes and leadership roles that focused on fairness and diversity. Some programmes showed success by increasing the number of women in leadership and helping people feel more supported and connected. The best results happened when organisations backed these efforts with clear plans and leaders responsible for making fairness a priority. Overall, the research shows that solutions that address the problem at different levels improve fairness, but there is still more work to do.
Hispanic youth in the United States have the highest rates of pediatric obesity and do not often meet national guidelines for physical activity and dietary intake. Family-based interventions can improve health outcomes in both youth and their parents and are highly relevant to Hispanics due to the cultural value of familismo (familism). However, few existing family-based obesity prevention interventions for Hispanics target adolescents and their parents, and those that do are not designed to facilitate widespread reach. This study describes the development of Healthy Juntos (Healthy Together), a family-based intervention for Hispanic adolescents and their parents that leverages the web and smartphone technology to prevent the onset of adolescent obesity by promoting healthy lifestyle behaviors (physical activity and diet). We used an iterative co-design process guided by the Integrate, Design, Assess, and Share (IDEAS) framework, which outlines 10 phases for developing digital interventions. Hispanic adolescents at risk for obesity and their parents (n=90; 45 dyads) participated across different phases of the intervention development process. We conducted qualitative interviews to understand their needs and preferences and to gather feedback on a series of intervention prototypes (conceptual, paper and minimally functional, and fully functional). Participants reported using technology for their health in limited ways (eg, to search for medical symptoms and recipes). They described the importance of having interactive and social features as part of a family-based digital health intervention. Their suggestions related to content, functionality, and aesthetics resulted in a fully functional prototype of a digital lifestyle intervention for Hispanic adolescents and their parents. The iterative co-design process was crucial for refining the Healthy Juntos intervention. Our next steps are to evaluate its feasibility, acceptability, and preliminary effects through a pilot randomized controlled trial.
BACKGROUND: To explore the relationship between receipt of amyloid-β PET scan results and subsequent experiences of economic strain and financial decision-making for persons with cognitive impairment and their care partners. METHODS: A parallel convergent mixed-methods design where quantitative and qualitative data were simultaneously collected and analyzed. Participants included a subset of community-residing Medicare beneficiaries with cognitive impairment who had an amyloid-β PET scan at a participating specialty center and their care partners, from the IDEAS study. Regression models tested associations between an elevated scan result and objective and subjective economic strain outcomes. Qualitative semi-structured interviews were conducted with patients and care partners ~24-36 months post-scan occurrence. RESULTS: Participants' mean age was 75, were majority White, non-Hispanic, highly educated, in good health, and well-resourced. Care partners were mainly spouses. Patients and care partners with elevated amyloid did not have higher economic strain at any post-disclosure time point compared to those with a negative scan. However, difficulty paying bills increased substantially for all participants over 18-24 months. Themes related to patient and care partner experiences of financial decision-making considering the scan were: 1) the need to make or update financial plans, 2) perceived care needs and financial resources for meeting care needs, and 3) involvement of family members in financial plans. CONCLUSIONS: Despite engaging in financial decision-making post-scan, participants reported experiencing economic strain, as measured by difficulty paying bills. More research is needed across the wealth distribution to develop methods for identifying and addressing economic strain experiences following a diagnosis of dementia.
BACKGROUND: Current evidence suggests that family physicians, who have traditionally provided a wide range of services across various settings, are choosing to reduce their scope of practice. This can have negative effects on communities that rely on family physicians to meet their diverse primary care needs. The College of Family Physicians of Canada (CFPC) spearheaded a curriculum review and renewal of postgraduate residency training to support broad-scope family medicine and specifically address six areas of evolving societal need: (i) home and long-term care; (ii) addiction and mental health; (iii) Indigenous health; (iv) health equity and anti-racism; (v) virtual care and health informatics; and (vi) leadership, advocacy, and scholarship. This study answered the following research question: Which learning outcomes for the six areas of societal need identified by the CFPC should be prioritized in family medicine postgraduate education, according to local stakeholders? METHODS: As part of a broad investigation, we conducted a descriptive study using the nominal group technique. Participants—researchers, clinical educators, and residents affiliated with a Canadian university—first generated ideas for learning outcomes and rated each idea’s importance on a five-point Likert scale. Then, they selected the five ideas per area of societal need that they believed to be of highest priority. RESULTS : Fifty-nine participants took part in six sessions in the fall of 2023. They generated and prioritized 227 learning outcomes, emphasizing topics related to patient-centred care and to personal and professional skills in care delivery. They also highlighted the need for both culturally safe care and a better understanding of the history of inequity in health care for marginalized populations. CONCLUSIONS : This study generated and prioritized many learning outcomes relevant to the six areas identified by the CFPC. Combined with national-level work and international consultations, this work provides actionable learning outcomes for family medicine residency training programs.
Accidental falls among older people pose a significant threat to both morbidity and mortality. Falls Hazard Reduction at Home (FHR@Home) when delivered by occupational therapists has been demonstrated as an effective fall prevention intervention. Despite the evidence, FHR@Home is not routinely implemented in practice. This scoping review seeks to explore existing literature to support implementation of FHR@Home by answering the question: 'What is known about implementation strategies used to support home and community environmental falls prevention intervention in health care?' This review used the Joanna Briggs Institute (JBI) methodological guidance for the conduct of scoping reviews. A comprehensive search was conducted across electronic databases, government websites, and web-based search engines. Studies were included if they incorporated FHR@Home as part of their intervention and explicitly referenced implementation science or knowledge translation concepts. Data were extracted from the included studies and reported implementation strategies were mapped using the Expert Recommendations for Implementing Change (ERIC) taxonomy and their associated clusters. A separate thematic analysis process was also conducted. There was no consumer and community involvement. Nineteen studies met the inclusion criteria. All ERIC implementation strategy clusters are reported on in the studies. Strategies relating to engagement and education of stakeholders appear more often in the literature. Three themes were identified as having influence on implementation outcomes: (1) Home as a practice context; (2) Collaboration is key to success; and (3) Balance of assumed knowledge, experience and fidelity. The findings underscore the need for further research to explore how implementation strategies can better support occupational therapists in delivering FHR@Home, particularly in ways that respect the consumer's sense of home while maintaining fidelity to evidence-based protocols. Expanding the literature in this area will be beneficial to improve uptake and sustainability of FHR@Home practices. For older people, falls can lead to serious injury and possible long‐term disability. Occupational therapists can help to prevent falls by working with older people in their homes to find and reduce falls hazards in a structured way. We call this Falls Hazard Reduction at Home or FHR@Home. Even though research shows FHR@Home works well, it is not always used in health care. We wanted to understand what helps support health services to use FHR@Home more regularly. To do this, we looked at research that included FHR@Home as part of falls prevention programs and that mentioned ideas from implementation science (a field that studies the ways we can support the use of good ideas in practice). We found 19 studies. Many of them focused on educating health workers and older people, as well as working closely with other people involved in falls prevention. We also found three important themes that affect the way we put FHR@Home into practice: (1) being in people's homes matters because it is not clinical, it is personal; (2) working closely with older people and other services is key to success; and (3) occupational therapists need to balance FHR@Home theory and their own knowledge and assumptions to get good outcomes. We suggest more research is needed to help health services use FHR@Home more often. Future work should focus on how to support older people's sense of home while making sure therapists follow best practices.
Competency committees serve as a holistic mechanism for determining whether learners have reached thresholds for advancement. In the United States, standards for competency committee operations are mandated throughout graduate medical education (GME) programs. Although similar committees have become increasingly prevalent in undergraduate medical education (UME), there is no external standard for their operations, and research is limited. This study aimed to address gaps in understanding the purpose, structure, and function of UME competency committees in US medical schools. This study was part of a larger focused ethnography conducted across 7 US MD-granting programs. Data were collected between April 2023 and November 2024 from site-specific documents (n = 21) and semistructured interviews with chairs (n = 7), an administrator (n = 1), and founders (n = 7) of the respective competency committees. Interviews were recorded and transcribed verbatim. The authors incorporated an interpretative approach to analyze data: generating and refining codes, developing institutional case summaries, and identifying emergent analytic ideas. Participants developed competency committees to serve as a critical component toward the aim of realizing a true competency-based education model. Despite the similar purpose, outcomes were variable, ranging from feedback and coaching to advancement and remediation. Competency was defined and operationalized locally; some identified numerical thresholds, whereas others favored individual judgment. Workload was commonly distributed between subgroups or subcommittees to navigate the large learner volume. Other critical considerations included the relationship between the competency committee and advancement committees, roles and responsibilities of members, and mitigation of conflicts. Although significant variability existed, participants encountered similar decision points, which illustrate key considerations for competency committee implementation in UME. This work provides a detailed description of competency committees in US medical schools, with important contrasts to GME, laying the groundwork for future research and best practices.
BACKGROUND: Didactic approaches to quality improvement (QI) are often perceived as insufficiently engaging, which may limit learner motivation and application of QI concepts. We developed a virtual reality (VR) escape room to reinforce core QI principles and conducted a Phase 1 evaluation focused on feasibility, usability, and perceived educational utility among medical learners and faculty. METHODS: We designed a 60-90-minute multi-puzzle VR escape room aligning with QI principles (terminology, SMART aims, root cause analysis, change ideas, Plan-Do-Study-Act cycles, run charts). Twenty-seven participants (undergraduate medical students, residents, faculty) formed teams of three to four. We collected post-session surveys (Likert, yes/no, free-text) and concurrent “think-aloud” observations during gameplay to characterize usability and perceived educational utility. Survey data were collected using a standardized questionnaire administered either electronically or verbally with items read verbatim and responses recorded without prompting. Free-test survey responses and think-aloud field notes were analyzed using a consistent inductive, theme-based approach, and closed-ended survey items were summarized descriptively. This evaluation was intended to inform iterative refinement of the intervention. RESULTS: Overall enjoyment was high (mean 3.9/5). Twenty-three of 27 participants (85%) reported that the VR escape room was perceived as helpful in reinforcing previously taught QI concepts. Analysis of survey free-text responses identified three themes: strengths of the experience (teamwork, engagement, collaborative problem solving), usability challenges (motion sickness, session length), and design preferences (variation in puzzle clarity and perceived linkage to QI concepts). Think-aloud findings similarly highlighted immersion, discussion, and collaboration as positive features, while hardware constraints and physical discomfort limited usability for some participants. Participant feedback informed iterative refinements related to puzzle design, facilitation, and technical setup. CONCLUSION: This Phase 1 pilot demonstrated that a VR escape room is a feasible and acceptable adjunct to existing QI teaching, providing learners with an immersive opportunity to apply previously introduced concepts. The main contribution of this study is feasibility and usability evidence, as well as implementation considerations (space, staffing, tolerability, and technical setup) to support educators considering immersive QI reinforcement activities. As objective knowledge outcomes were not assessed, future work will evaluate educational effectiveness using pre/post testing and comparative non-VR conditions following further refinement and curricular integration.
Implicit bias and structural racism in pediatric health care cause significant inequities and poorer outcomes. To help educate pediatric health-care providers, health equity rounds (HER) engage teams in discussions on the impact of bias and racism on patient care using a case-based curriculum. This mixed-methods study assessed the feasibility and acceptability of incorporating HER in a pediatric emergency medicine (PEM) setting. Two HERs, focusing on implicit bias in medicine (June 2021) and linguistic barriers to health care (December 2021), were completed during the institution's multidisciplinary, PEM update rounds. Cases presented were selected if patient care and/or outcomes were negatively affected, were appropriate for educational discussion and relevant to the presentation topic. HER participants were invited to complete an online survey and semi-structured interview post-HER to explore their experiences, including professional and personal impacts. Both HERs were well-attended and had a moderate survey uptake (20/25 vs. 14/22). Three-quarters of survey participants found HER engaging (80%), and believed the learned objectives would impact their clinical practice (73.7% vs. 78.6%). Responses varied between presentations for educational value (80% vs. 61.6%) and interest in future HERs (94.7% vs. 78.6%). Four themes emerged from 3 qualitative interviews: HER satisfaction and experience, influence on service provision, supports and resources, and ideas for future HERs. Our findings suggest HER is an acceptable and feasible forum for discussing and reflective practice on relevant topics in PEM educational sessions. Implementing HER in other specialized areas or settings and the impact of different topics should be explored further.
IntroductionMental health in children is significantly influenced by socio-economic status, poverty, and income inequality. However, existing child psychiatric research focuses on clinical variables and developed nations. Hence, this study explored the impact of these factors on the psychosocial functioning of children visiting a mental health clinic in India.MethodsA cross-sectional research design was employed, with data collected from children and their parents/caregivers using the Children's Global Assessment Scale (CGAS) and Indian Disability Evaluation and Assessment Scale (IDEAS). Participants included 120 children recruited from an out-patient clinic in a tertiary mental healthcare center. Non-parametric tests were employed to examine the influence of socio-economic status and poverty on functioning among the participants.ResultsOur study observed significant differences in functioning scores related to socio-economic status, monthly family income, and sources of income, with family income source significantly affecting disability scores. A significant proportion of the participants scored below the functioning benchmark and above the disability benchmark.ConclusionSocio-economic disparities and income inequality significantly influence mental health outcomes. The findings emphasize the role of social determinants of mental health and underscore the importance of integrating mental health services with socio-economic support systems. Socio-economic status and poverty are not merely background factors; they are foundational determinants of mental health and psychosocial functioning among children, particularly those living with severe mental illness. In the Indian context, where sources of family income may be unstable and informal, these factors play a crucial role. While some families appear to have higher incomes from organized sectors, high financial burdens, including educational expenses, healthcare costs, household expenditures, and debts sustain chronic financial stress. This chronic economic strain undermines any surface-level financial security, leaving children highly vulnerable. This is the first study in the Indian context to examine the influence of income, socio-economic status, and poverty on psychosocial functioning and disability among children with severe mental illness. Our findings offer critical insights into the severe impact of impoverished living conditions on child development and functioning.
Despite global commitments to eliminate mother-to-child transmission of HIV and syphilis, political and resource prioritization remains uneven across low- and middle-income countries. This has led to disparities in financial investment, policy implementation, and health outcomes. This study examines the factors shaping political prioritization of prevention of mother-to-child transmission (PMTCT) in Ghana, Mozambique, and Sudan using the Shiffman and Smith framework to understand how political, institutional, and contextual forces interact to influence national responses. A qualitative, cross-country comparative policy analysis was conducted based on document review from 3 data sources. Across countries, we included 21 government documents, 22 documents from non-governmental organizations, and 15 peer-reviewed articles selected through theoretical sampling. Both inductive and deductive thematic analyses were applied, with the latter guided by the Shiffman and Smith framework. Political prioritization of PMTCT was influenced by interrelated domains including actor power, ideas, political context, information systems, and financial resources. Ghana and Mozambique achieved higher prioritization through cohesive advocacy networks, effective issue framing, strong political commitment, reliable data, and sustained donor support. In contrast, Sudan's limited progress reflected low political commitment due to fragmented leadership, weak coordination, inadequate data, and chronic resource constraints. The findings illustrate that progress depends not only on individual determinants but also on their interaction within national policy systems. Political prioritization of PMTCT results from the interaction of multiple interlinked factors rather than any single determinant. Strong advocacy, effective framing, reliable data, and sustained funding within supportive political environments foster commitment, as seen in Ghana and Mozambique. Coordinated advocacy, credible evidence, and predictable investment are essential to strengthen the PMTCT program by translating the global elimination goals into actionable national strategies.
Objective: The current study assessed outcomes of a continuing professional education program aimed at managing job-related stress to assist employees with recognizing and managing burnout and enhancing both productivity and overall well-being. Study Design: This study outlines the implementation of a needs assessment survey and the development of a non-credit training course for working professionals that addressed risks of burnout, suicidality, and self-care strategies to support mental health in the workplace. Methods: The sample for the current study consisted of 398 predominantly mid- to senior-level professionals. Participants were divided into two cohorts. The first cohort completed a structured needs assessment survey between June 2023 and July 2023 and provided ideas for curriculum development. The second cohort participated in synchronous, instructor-led virtual training sessions and completed pre- and post-training questionnaires between January 2024 and June 2024. A mixed-method content analysis was conducted to identify recurring themes and their frequency in course questionnaires. Results: Findings suggest that the training successfully expanded participants' understanding of signs of burnout and of new approaches to improve well-being in the workplace including forming friendships, engaging in mindfulness activities, and taking time off for a mental health day. Conclusions: Future research should explore the long-term impacts of such interventions and compare delivery methods, including virtual and in-person formats, to determine the most effective approaches for promoting mental well-being at work.
Opioid use disorder (OUD) exists in approximately 1% of US pregnancies and is associated with increased risk of severe maternal morbidity and mortality. Many pregnant individuals with OUD also have a stimulant use disorder (StUD), but it is unclear whether this co-occurring condition changes the types of treatment services they receive. We compared treatment services received during pregnancy between individuals with both OUD and StUD and those only with OUD. A retrospective cohort study used 2014-2017 data from the Utah All-Payer Claims Database. The sample included pregnancies ≥20 weeks' gestation among individuals aged 15-49 years with ≥4 weeks of insurance enrollment and excluded pregnancies with outcome events occurring <28 weeks after the estimated conception date. Identification of OUD and StUD relied on ICD-9/10 diagnosis codes. Outcomes were receipt of (1) medication for OUD (MOUD; formulations of buprenorphine or methadone administration), (2) outpatient psychosocial services (evaluation and management/assessment services and psychotherapy/counseling or other psychosocial visits), and (3) higher-intensity treatment (intensive outpatient, partial hospitalization, or residential treatment). Logistic generalized estimating equation models, adjusted for demographic and clinical covariates, estimated odds of receiving each service and any service overall. Among 146,239 insurance beneficiaries, we identified 1206 pregnancies with OUD, including 305 (25.3%) with co-occurring StUD and 901 (74.7%) only with OUD. Pregnant individuals with StUD and OUD compared to those only with OUD had lower odds of receiving MOUD (adjusted odds ratio [aOR], 0.68; 95% CI, 0.48-0.96) and higher odds of receiving psychotherapy/counseling or other psychosocial visits (aOR, 2.73; 95% CI, 2.01-3.71) and higher-intensity treatment (aOR, 3.47; 95% CI, 1.58-7.59). There were no differences between groups in receipt of evaluation and management/assessment services (aOR, 0.97; 95% CI, 0.83-1.14) or of any treatment service overall (aOR, 1.07; 95% CI, 0.94-1.21). In this sample of Utah insurance beneficiaries, pregnant individuals with co-occurring StUD and OUD were less likely to receive MOUD and more likely to receive psychosocial and higher-intensity services than those only with OUD.
Beyond their glycaemic benefits, automated insulin delivery (AID) systems can provide psychosocial benefits for people with type 1 diabetes (T1D) and improve quality of life. In this study, we evaluated psychosocial outcomes in adults with T1D using the tubeless Omnipod® 5 AID System compared with sensor augmented pump (SAP) therapy. As part of a 13-week multicentre, parallel-group, randomised controlled trial comparing intervention (tubeless AID) and control (SAP) groups (2:1), adults aged 18-70 years with T1D completed validated psychosocial questionnaires assessing health-related quality of life (European Quality of Life 5 Dimensions 3 Level Version [EQ-5D-3L] index score and visual analogue scale [VAS]), the impact of diabetes on quality of life (DAWN2 Impact of Diabetes Profile [DIDP]), sleep quality (Pittsburgh Sleep Quality Index [PSQI]), system usability (System Usability Scale [SUS]) and perceptions before and experiences after using AID systems (INsulin Dosing Systems: Perceptions, Ideas, Reflections and Expectations [INSPIRE]). The intervention group saw greater score improvements than the control group for all measures evaluated, including health-related quality of life (EQ-5D-3L VAS, p = 0.01; EQ-5D-3L index score, p = 0.002), impact of diabetes on quality of life (DIDP, p = 0.004), perceived system usability (SUS, p < 0.0001) and sleep quality (PSQI, p = 0.03). INSPIRE scores, determined only for the intervention group, were high at baseline and follow-up, suggesting positive perceptions of tubeless AID. This randomised controlled trial demonstrated that the use of a tubeless AID system improved psychosocial measures to a greater extent than SAP therapy. These results contribute to the growing body of evidence demonstrating that AID may improve quality of life and alleviate some of the burden associated with diabetes self-management in adults with T1D.
To assess the short-term adjunctive effect of systemic antibiotics on non-surgical periodontal therapy and to identify predictors of treatment response in the patients with stages Ⅲ/Ⅳ periodontitis, providing ideas for precise clinical medication. A retrospective study was conducted on the patients who received non-surgical periodontal treatment in the Department of Periodontology, Peking University School and Hospital of Stomatology from November 2007 to February 2015. A total of 521 patients with stages Ⅲ/Ⅳ periodontitis were included. Participants were divided into two groups: those who received systemic antibiotic therapy adjunctive to scaling and root planing (SRP) (antibiotic group, n=204) and those who underwent SRP only (non-antibiotic group, n=317). The timing of systemic antibiotic use is divided into before SRP, during SRP, and after SRP. The primary outcome was defined as the relative change in the percentage of sites with probing depth (PD) ≥5 mm. Univariable linear regression was used to identify the association between each variable and treatment efficacy, and multivariable linear regression was utilized to adjust for confounding factors and to determine the relationships of antibiotic therapy, age of the antibiotic group, and timing of antibiotic administration with the treatment efficacy. Furthermore, smooth curve fitting and piecewise linear regression model were employed to assess the potential nonlinear relationship and threshold effect between age and treatment response in the anti-biotic group. The threshold was identified by evaluating a series of potential turning points within predefined intervals and selecting the point with the maximum model likelihood. Both treatment groups exhibited significant improvements in all periodontal parameters following therapy (P < 0.001). After adjustment for potential confounders, multivariable analysis revealed a significantly greater reduction in the percentage of sites with PD≥5 mm in the antibiotic group versus the non-antibiotic group (β=16.33, 95% CI: 13.40－19.27, P < 0.001). Within the antibiotic group, we identified a nonlinear association between age and therapeutic efficacy, with an inflection point at 38 years. The patients aged ≤38 years responded significantly better than those older than 38 years (P=0.022). Furthermore, the timing of antibiotic administration was a significant determinant of outcome. The most pronounced efficacy was achieved when antibiotics were administered concurrently with SRP, surpassing both pre- and post-SRP administration. Our findings suggest that the use of systemic antibiotics as an adjunct to SRP is associated with enhanced short-term clinical outcomes in stages Ⅲ and Ⅳ periodontitis. During SRP, treating younger patients (≤38 years old) with systemic antibiotics as an adjunct may yield better therapeutic effects. 评价全身应用抗生素对Ⅲ期和Ⅳ期牙周炎患者牙周机械治疗短期疗效的辅助作用, 并探索影响疗效的关键因素, 为临床精准用药提供参考。 选择2007年11月至2015年2月在北京大学口腔医院牙周科接受过牙周机械治疗的患者的病例资料进行回顾性分析, 共纳入521例Ⅲ/Ⅳ期牙周炎患者, 根据是否在龈下刮治和根面平整(scaling and root planing, SRP)基础上全身应用抗生素, 将患者分为抗生素组(n=204)和非抗生素组(n=317), 根据抗生素使用时机将抗生素组分为SRP前, SRP中和SRP后3个亚组。主要结局指标为探诊深度(probing depth, PD)≥5 mm的位点百分比变化。通过单因素线性回归分析确定各因素与疗效的关联, 采用多因素线性回归分析确定抗生素使用、抗生素组年龄和用药时机等因素与疗效的关联, 进一步采用平滑曲线拟合与分段线性回归模型评估抗生素组中年龄和疗效的非线性关联和阈值效应, 阈值通过在预定义区间内寻找使模型似然值最大的转折点来确定。 治疗后, 两组患者的牙周指标均显著改善(P < 0.001)。多因素分析校正混杂因素后发现, 与非抗生素组相比, 抗生素组PD≥5 mm位点百分比减少更显著(β=16.33, 95%CI: 13.40~19.27, P < 0.001)。在抗生素组内, 年龄与疗效存在非线性关系, 以38岁为拐点, ≤38岁的患者疗效显著优于>38岁的患者(P=0.022)。此外, 用药时机显著影响疗效, 在SRP治疗期间(SRP中)使用抗生素的疗效最佳, 优于SRP前或SRP后用药。 在SRP基础上辅助全身应用抗生素, 可进一步改善Ⅲ期和Ⅳ期牙周炎患者的短期临床疗效; 在SRP治疗期间, 对年龄较轻(≤38岁)的患者辅以全身抗生素治疗, 可能取得更好的疗效。
BACKGROUND: Research on the impacts of the COVID-19 pandemic on long-term care workers has largely emphasized the negative outcomes of crisis conditions and workforce distress, leaving strengths-based perspectives on workers’ experiences during this period underexplored. Recognizing the potential of strengths-focused inquiry to inform sector transformation and workforce renewal, we conducted a secondary qualitative analysis of Canadian long-term care worker experiences during the pandemic using an Appreciative Inquiry lens to examine and more fully represent workers’ strengths. METHODS: A qualitative secondary analysis was conducted using an Appreciative Inquiry theoretical lens. Data were collected during the COVID-19 pandemic through semi-structured interviews with 50 long-term care staff members spanning diverse roles across 12 facilities in Alberta, British Columbia, and Ontario. Transcripts were analysed thematically in a process of moving from inductive familiarisation to deliberate application of an appreciative lens to identify successes, assets, and positive capacities within the long-term care workforce. RESULTS: We present three themes identifying interlocking expressions of strength. First, during crisis, workers stretched roles, redistributed tasks, and supported one another to sustain care under extreme constraint. Second, staff upheld person-centred care in their daily actions, working from values of dignity, relationships, and residents’ goals. Third, workers translated experience into learning and advocacy, articulating ideas to improve staffing, role clarity, leadership practices, and visitation approaches. Across these expressions, workers’ tenacity, togetherness, and shared purpose enabled collective action, although these strengths often entailed costs such as fatigue and moral strain. CONCLUSION: Our findings add to existing literature on long-term care worker experiences during the pandemic by demonstrating that workers’ capacities for adaptability, person-centred care, and advocacy are vital assets for sector renewal. While amplifying and supporting worker strengths can enable meaningful transformation, these strengths alone cannot substitute for systemic investment and reform. To sustain care quality, workforce well-being, and crisis preparedness, interventions and policy design should embed worker perspectives to advance recognition and resourcing of their contributions. Deeper renewal also requires rewriting longstanding public narratives that undervalue LTC work.